the socio economic impact of radiation treatments on patients and …€¦ · of radiation...
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The Socio Economic Impact of radiation treatments on patients and their families
Jeanette Hardwick, RTT, MBA
Supervising Radiation Therapist
Radiation Medicine Department
Roswell Park Cancer Institute Buffalo, NY
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Cancer is one of the world's major diseases:
• burden on patients/families
• direct and indirect financial implications for
patients/ families-with long lasting effects
• a loss of family income, social isolation, family
tensions and adversely effects daily functioning
of the family
Economic Impact of Cancer
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Studies have shown that financial burden:
• harm the quality of cancer care
• patients concerned they'll receive lesser-quality
care if they talk about their financial burden
• they remain silent
(asco.org)
Economic Impact of Cancer
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Economic Impact of Cancer
The financial burden of cancer treatment has
been termed Financial Toxicity.
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Medical debt is the #1 cause of personal
bankruptcy in the USA:
• not to be taken lightly
• long term consequences that influence
• get credit
• finance a home or a car
Economic Impact of Cancer
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Why is the cost of cancer treatment rising?
§ patients are living longer- as a result are
receiving more treatment, costs can build
§ patients are expected to bear a larger portion of
the overall cost in the form of cost sharing
Economic Impact of Cancer
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Why is the cost of cancer treatment rising?
§ Increasing costs for latest treatment technology
§ Advanced treatment planning techniques such
as IMRT and SBRT are more expensive because
of the increased physician and treatment
planning time involved (asco.com)
Economic Impact of Cancer
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Economic Impact of Cancer
Radiation therapy can cost $10,000-$55,000 or
more -depending on the type of treatment.
The median cost of a course of radiation therapy:
• $8,600 ($7,300 to $10,300) for breast
• $9,000 ($7,500 to $11,100) for lung
• $18,000 ($11,300 to $25,500) for prostate
(onclive.com)
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Managing the Economic Impact
3 Fx SBRT $14,000 Patient $ 135 29 Fx $20,000 Patient $ 1,275 1 Fx SBRT $ 10,000 Patient $ 0 5 Fx SBRT $ 19,000 Patient $ 135
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Managing the Economic Impact
37 Fx $26,000 Patient $ 20 45 Fx $28,000 Patient $2,373 45 Fx $38,000 Patient $0
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Managing the Economic Impact
33 Fx $8,000 Patient $ 3
21 Fx $17,000 Patient $15
15 Fx $10,000 Patient $ 270
21 Fx $9,500 Patient $716
30 Fx $23,000 Patient $ 825
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Managing the Economic Impact
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Managing the Economic Impact
• 33 Fx breast treatment
• 33 x $25 = $825
• The example patient had 33 treatments
• Paid $825
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• 63% patients wanted to discuss costs with MD
• "conundrum": patients want to talk about cost
• don't want MD making decisions based on cost
• The financial costs of cancer are high for both
the person with cancer, family and for society
• AHRQ estimates that the direct medical costs for
cancer in the US in 2011 were $88.7 billion.
(cancer.org)
Economic Impact of Cancer
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The breakdown of direct medical costs:
• 50% hospital outpatient or doctor office visits
• 35% inpatient hospital stays
• 11% prescription drugs
(cancer.org)
Economic Impact of Cancer
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Patients will need:
• regular follow-up visits
• visit a doctor every 3 to 4 months for 2 or 3 years
every 6 months to a year
• Blood tests, MRIs or CT scans
• Follow-up visits can cost from $200 to $400
(cancer.gov)
Economic Impact of Cancer
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Cancer:
• 2nd most common cause of death in US
• accounts for 1 out of every 4 deaths in the US
(wninstituteforwellness.com)
• Total cost cancer care in U.S. is more than $150
billion by 2020
(npr.org)
Economic Impact of Cancer
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• annual cost of cancer in the U.S. at $216.6 billion
including direct medical costs
• all health expenditures
• indirect mortality costs
• lost productivity due to premature death
(wninstituteforwellness.com)
Economic Impact of Cancer
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Economic Impact of Cancer
Medical expenses arise from:
• Doctor visits
• Lab tests
• Clinic visits for treatments
• Procedures
• Imaging tests
(patientresource.com)
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• Radiation treatments
• Drug costs
• Hospital stays
• Surgery
• Home care
(patientresource.com)
Economic Impact of Cancer
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Less obvious increases in routine living expenses:
• gas, parking or traveling
• legal help and financial services
• child or elder care
• Income may be reduced
• Benefits may be reduced or lost
• Adjust to a permanently reduced income
Economic Impact of Cancer
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Patients with cancer are at risk of:
• 2.65 times more likely to declare bankruptcy
• Younger people diagnosed experience higher
bankruptcy rates than those 65 years or older
• Indebtedness is common and can be severe
• 25% were in debt because of treatment
• the average debt was $26,860
(Source: Health Affairs)
Economic Impact of Cancer
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Economic Impact of Cancer
Patients with cancer are at risk of:
• cutting down or stop spending on food/
clothing
• forgo paying bills for utilities, cable, credit
cards, loans and mortgages
• draining out retirement and savings accounts
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Economic Impact of Cancer
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Economic Impact of Cancer
Financial issues continue after treatment has ended
• Survivors are forced into early retirement
• No health insurance coverage
Difficult to find another job with:
• health
• disability
• life insurance benefits (mdanderson.org)
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Economic Impact of Cancer
• 1 in 2 men and 1 in 3 women will develop
cancer in their lifetime
• Face an all-encompassing battle
• Battle’s scars-physical, emotional and financial
• can linger after treatment ends and as life
returns to “normal”
(wninstituteforwellness.com)
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The costs of cancer treatment impact patients:
• adherence to treatment
• employment status
• long-term financial well-being
• financial problems predict poor quality of life
(CDC.org)
Economic Impact of Cancer
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• compared with people without a cancer
diagnosis
• cancer survivors are less likely to work and
more likely to struggle financially
• cancer-related financial problems are the
strongest independent predictor of survivors’
quality of life
(CDC.org)
Economic Impact of Cancer
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• 9% of patients stated they decided “to not have
a recommended cancer treatment because it
was too expensive“
• 25% for with an income < $40,000
• 36% small amount distress
• 19% large amount distress
(jop.ascopubs.org)
Economic Impact of Cancer
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• 20% medical benefits provided less money
than anticipated
• 75% constantly worry about financial issues
due to cancer treatment
• 25% belonged to an HMO or Medicare
• > 40% were over 60 years old
(jop.ascopubs.org)
Economic Impact of Cancer
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• 26% $0-$1,000 out of pocket
• 42% $1,000-$10,000 out of pocket
• 12% $10,000-$25,000 out of pocket
• 4% $25,000-$50,000 out of pocket
• 2% $50,000-$100,000 out of pocket
• 2% > $100,000
Economic Impact of Cancer
(jop.ascopubs.org)
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• 1 in 5 adults in the US is underinsured
• number insured patients is increasing
• insured patients are paying more out of pocket
due to increased cost sharing
• number underinsured cancer patients is
increasing
• 75% applied for drug copayment assistance
(theoncologist.org)
Economic Impact of Cancer
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• greater out-of-pocket costs
• treatment decision making made without
consideration of these expenses
• 42% significant or catastrophic financial
burden
• Never even start due to the catastrophic
costs of cancer treatment
(theoncologist.org)
Economic Impact of Cancer
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• 68% cut back on leisure activities
• 46% reduced spending on food or clothing
• 46% used savings to defray out-of-pocket
expenses
• 7% of patients avoided procedures or tests
(theoncologist.org)
Economic Impact of Cancer
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• 20% took less than the prescribed amount of
medication
• 9% partially filled prescriptions
• 24% avoided filling prescriptions altogether
• 7% spread out chemo or clinic appointments
• 4% skipped appointments
(theoncologist.org)
Economic Impact of Cancer
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Economic Impact of Cancer
2020 costs are projected to reach at least $158 billion and be as high as $207 billion 2010 costs were $124.6 billion: • breast cancer $16.5 billion • colorectal cancer $14 billion • lymphoma $12 billion • lung cancer $12 billion • prostate cancer $12 billion
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Economic Impact of Cancer
An Example of the impact cancer treatment has:
-Breast cancer diagnosis
-Madison, NJ
-57 years old
-Married to firefighter
-Believes had ‘superb’ insurance
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-Never considered not affording treatment
-Told insurance would no longer pay
-Stopped going
-The hospital agreed
-Treatments resumed
-Patient ended up with the bills
Economic Impact of Cancer
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So then, what can be done to reduce the financial toxicity of cancer treatments for patients?
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Managing the Economic Impact
Become ‘patient active’- people who
participate in their care, along with their
health care team and loved ones, will improve
the quality of their lives and may enhance the
possibility of recovery.
(cancersupportcommunity.org)
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Managing the Economic Impact
• Financial counselors, social workers, case managers, or patient navigators they can help or provide referrals to support services/financial resources
• Have a family member/friend help with the
task of looking at bills, keeping them in one place
• Task of looking over medical bills too much of
a burden ‘financial toxicity’
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Economic Impact of Cancer
• 69% of social workers see themselves as a primary resource dealing with the financial concerns
• the majority of social workers they have a
significant impact in helping oncology patients • 34% of patients report utilizing a social worker
as a resource.
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Economic Impact of Cancer
• help cancer patients become more educated potential costs of care
• diagnosed it’s not a surprise • doesn’t add to the stress during recovery • financial burden can be devastating and
negatively affect patient’s quality of life
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Managing the Economic Impact
Patient navigators:
• Facilitate enrollment in health care exchange
• plans Help patients enroll in Medicaid/Medicare
• Apply for social security and disability benefits
• aid the patient to apply for free medications
• identify external sources help pay for treatment
(onclive.com)
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Managing the Economic Impact
• National service organizations
• Local service organizations
• Housing assistance
• Travel assistance
• Medication and treatment cost assistance
• General financial information
(Cancer.net)
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Managing the Economic Impact
National service organizations
• Cancer Financial Assistance Coalition(CFAC)
• CancerCare
• HealthWell Foundation
• American Cancer Society
• United Way
• National Cancer Information Center (NCIC)
(Cancer.net)
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Managing the Economic Impact
Local service organizations
• Catholic Charities
• Jewish Social Services
• The Lions Club
• Lutheran Social Services
• The Salvation Army
(Cancer.net)
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Managing the Economic Impact
Local service organizations
• Department of Social Services
• Churches, synagogues, mosques, and lodges
• Hospitals
• Cancer Advocacy groups
• Patient Information groups
(Cancer.net)
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Managing the Economic Impact
Housing assistance
• Healthcare Hospitality Network
• American Cancer Society’s Hope Lodge
and Hotel Partners Program
• Joe’s House
• Ronald McDonald House Charities
(Cancer.net)
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Managing the Economic Impact
Travel assistance
• National Patient Travel Center
• Angel Airline Samaritans
• Corporate Angel Network
• American Cancer Society
• Road to Recovery
• Transportation Assistance
(Cancer.net)
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Managing the Economic Impact
Medication and treatment cost assistance
• NeedyMeds.com
• Partnership for Prescription Alliance
• Patient Access Network Foundation
• Patient Services, Inc.
• RxHope.com
(Cancer.net)
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Managing the Economic Impact
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Managing the Economic Impact
General financial information
• Patient Advocate Foundation
• CancerCare
• Cancer Family Relief Fund
• LIVESTRONG
• Susan G. Komen Foundation
(Cancer.net)
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Managing the Economic Impact
General information
-Have 2nd person go to all appointments
-Take notes and ask questions
-Keep binder with all appointments/bills
-Double check bills
-Note reasons for appointment
-Ask about patient resources, social services….
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Managing the Economic Impact
General information
-Find support groups
-Read literature given
-Be open to advice given
-Ask for help (don’t wait or delay asking)
-Know your caregivers and what they do
-Look Good….Feel better
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Managing the Economic Impact
General information
-Start a medical reimbursement account
-Help to cover co payments
-Can minimize the financial toxicity of treatment
-Get specifics on your insurance coverage such
as co payment amounts, what is covered
-Be advocate for yourself and what works for you
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http://www.cancer.org/cancer/cancerbasics/economic-impact-of-cancer http://www.npr.org/sections/health-shots/2015/04/14/398419692/big-bills-a-hidden-side-effect-of-cancer-treatment http://wninstituteforwellness.com/media/230519/WN-BR-STDY2-0914.pdf http://www.patientresource.com/Financial_Overview.aspx http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-topics/survivorship/side-effects-of-cancer-treatment/legal-impact.html http://www.cdc.gov/nchs/fastats/cancer.htm http://jop.ascopubs.org/content/6/2/69.full.pdf+html http://ww5.komen.org/BreastCancer/FinancialResources.html
References
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http://theoncologist.alphamedpress.org/content/18/4/381.long http://www.socialworktoday.com/archive/032210p14.shtml http://www.cancersupportcommunity.org/MainMenu/About-Cancer/Understanding-Cancer/Coping-with-the-Cost-of-Care/Where-do-I-begin.html http://www.cancer.net/navigating-cancer-care/financial-considerations/financial-resources ** http://quality.asco.org/financial-toxicity’s-effects-quality-cancer-care-conversation-dr-yousuf-zafar http://www.oncolink.org/coping/article.cfm?c=538&id=1173 http://jco.ascopubs.org/content/25/2/180.full http://www.statista.com/statistics/238684/us-average-health-insurance-copay-amount/
References
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http://jop.ascopubs.org/content/early/2014/10/14/JOP.2014.001495.full.pdf+html http://jnci.oxfordjournals.org/content/2011/Mariotto/117/28.full.pdf+html http://www.cancer.org/treatment/findingandpayingfortreatment/managinginsuranceissues/the-cost-of-cancer-treatment http://www.npr.org/sections/health-shots/2015/03/26/395512917/how-much-does-cancer-cost-us http://www.ispor.org/news/articles/March-April2014/IC_Vol20_Issue2_Economic_Eval_Financial_Toxicity_A_Growing_Concern_Among_Cancer_Patients_in_the_United_States.pdf http://www.onclive.com/publications/oncology-business-news/2015/September-2015/radiation-cost-study-shows-inefficiency-of-fee-for-service#sthash.Q58RYQko.dpuf http://www.ascopost.com/issues/march-15-2012/rising-costs-in-radiation-oncology-linked-to-medicare-coverage.aspx
References